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Initial experience using intensity-modulated radiotherapy for recurrent nasopharyngeal carcinoma.
Int J Radiat Oncol Biol Phys. 2004 Mar 01; 58(3):682-7.IJ

Abstract

PURPOSE

To report our initial experience on the feasibility, toxicity, and tumor control using intensity-modulated radiotherapy (IMRT) for retreatment of recurrent nasopharyngeal carcinoma (NPC).

METHODS AND MATERIALS

A total of 49 patients with locoregional recurrent carcinoma in the nasopharynx were treated with IMRT between January 2001 and February 2002 at the Sun Yat-Sen University Cancer Center, Guangzhou, China. The average time to the nasopharyngeal recurrence was 30.2 months after initial conventional RT. The median isocenter dose to the nasopharynx was 70 Gy (range 60.9-78.0) for the initial conventional RT. All patients were restaged at the time of recurrence according to the 1992 Fuzhou, China staging system on NPC. The number of patients with Stage I, II, III and IV disease was 4, 9, 10, and 26, respectively. T1, T2, T3, and T4 disease was found in 4, 9, 11, and 25 patients, respectively. N0, N1, N2, and N3 disease was found in 46, 2, 0, and 1 patient, respectively. Invasion of the nasal cavity, maxillary sinus, ethmoid sinus, sphenoid sinus, and cavernous sinus and erosion of the base of the skull was found in 8, 1, 3, 8, 15, and 20 patients, respectively. The gross tumor volume (GTV) was contoured according to the International Commission on Radiation Units and Measurements (ICRU) Report 62 guidelines. The critical structures were contoured, and the doses to critical structures were constrained according to ICRU 50 guidelines. The GTV in the nasopharynx and positive lymph nodes in the neck received a prescription dose of 68-70 Gy and 60 Gy, respectively. All patients received full-course IMRT. Three patients who had positive lymph nodes were treated with five to six courses of chemotherapy (cisplatin + 5-fluorouracil) after IMRT.

RESULTS

The treatment plans showed that the percentage of GTV receiving 95% of the prescribed dose (V(95-GTV)) was 98.5%, and the dose encompassing 95% of GTV (D(95-GTV)) was 68.1 Gy in the nasopharynx. The mean dose to the GTV was 71.4 Gy. The average doses of the surrounding critical structures were much lower than the tolerable thresholds. At a median follow-up of 9 months (range 3-13), the locoregional control rate was 100%. Three cases (6.1%) of locoregional residual disease were seen at the completion of IMRT, but had achieved a complete response at follow-up. Three patients developed metastases at a distant site: two in the bone and one in the liver and lung at 13 months follow-up. Acute toxicity (skin, mucosa, and xerostomia) was acceptable according to the Radiation Therapy Oncology Group criteria. Tumor necrosis was seen toward the end of IMRT in 14 patients (28.6%).

CONCLUSION

The improvement in tumor target coverage and significant sparing of adjacent critical structures allow the feasibility of IMRT as a retreatment option for recurrent NPC after initial conventional RT. This is the first large series using IMRT to reirradiate local recurrent NPC after initial RT failed. The treatment-related toxicity profile was acceptable. The initial tumor response/local control was also very encouraging. In contrast to primary NPC, recurrent NPC reirradiated with high-dose IMRT led to the shedding of tumor necrotic tissue toward the end of RT. More patients and longer term follow-up are warranted to evaluate late toxicity and treatment outcome.

Authors+Show Affiliations

Department of Radiation Oncology, Cancer Center, Sun Yat-Sen University, Guangzhou, People's Republic of China.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

14967420

Citation

Lu, Tai-Xiang, et al. "Initial Experience Using Intensity-modulated Radiotherapy for Recurrent Nasopharyngeal Carcinoma." International Journal of Radiation Oncology, Biology, Physics, vol. 58, no. 3, 2004, pp. 682-7.
Lu TX, Mai WY, Teh BS, et al. Initial experience using intensity-modulated radiotherapy for recurrent nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys. 2004;58(3):682-7.
Lu, T. X., Mai, W. Y., Teh, B. S., Zhao, C., Han, F., Huang, Y., Deng, X. W., Lu, L. X., Huang, S. M., Zeng, Z. F., Lin, C. G., Lu, H. H., Chiu, J. K., Carpenter, L. S., Grant, W. H., Woo, S. Y., Cui, N. J., & Butler, E. B. (2004). Initial experience using intensity-modulated radiotherapy for recurrent nasopharyngeal carcinoma. International Journal of Radiation Oncology, Biology, Physics, 58(3), 682-7.
Lu TX, et al. Initial Experience Using Intensity-modulated Radiotherapy for Recurrent Nasopharyngeal Carcinoma. Int J Radiat Oncol Biol Phys. 2004 Mar 1;58(3):682-7. PubMed PMID: 14967420.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Initial experience using intensity-modulated radiotherapy for recurrent nasopharyngeal carcinoma. AU - Lu,Tai-Xiang, AU - Mai,Wei-Yuan, AU - Teh,Bin S, AU - Zhao,Chong, AU - Han,Fei, AU - Huang,Yin, AU - Deng,Xiao-Wu, AU - Lu,Li-Xia, AU - Huang,Shao-Min, AU - Zeng,Zhi-Fan, AU - Lin,Cheng-Guang, AU - Lu,Hsin H, AU - Chiu,J Kam, AU - Carpenter,L Steven, AU - Grant,Walter H,3rd AU - Woo,Shiao Y, AU - Cui,Nan-Ji, AU - Butler,E Brian, PY - 2003/03/13/received PY - 2003/07/03/revised PY - 2003/07/11/accepted PY - 2004/2/18/pubmed PY - 2004/3/25/medline PY - 2004/2/18/entrez SP - 682 EP - 7 JF - International journal of radiation oncology, biology, physics JO - Int J Radiat Oncol Biol Phys VL - 58 IS - 3 N2 - PURPOSE: To report our initial experience on the feasibility, toxicity, and tumor control using intensity-modulated radiotherapy (IMRT) for retreatment of recurrent nasopharyngeal carcinoma (NPC). METHODS AND MATERIALS: A total of 49 patients with locoregional recurrent carcinoma in the nasopharynx were treated with IMRT between January 2001 and February 2002 at the Sun Yat-Sen University Cancer Center, Guangzhou, China. The average time to the nasopharyngeal recurrence was 30.2 months after initial conventional RT. The median isocenter dose to the nasopharynx was 70 Gy (range 60.9-78.0) for the initial conventional RT. All patients were restaged at the time of recurrence according to the 1992 Fuzhou, China staging system on NPC. The number of patients with Stage I, II, III and IV disease was 4, 9, 10, and 26, respectively. T1, T2, T3, and T4 disease was found in 4, 9, 11, and 25 patients, respectively. N0, N1, N2, and N3 disease was found in 46, 2, 0, and 1 patient, respectively. Invasion of the nasal cavity, maxillary sinus, ethmoid sinus, sphenoid sinus, and cavernous sinus and erosion of the base of the skull was found in 8, 1, 3, 8, 15, and 20 patients, respectively. The gross tumor volume (GTV) was contoured according to the International Commission on Radiation Units and Measurements (ICRU) Report 62 guidelines. The critical structures were contoured, and the doses to critical structures were constrained according to ICRU 50 guidelines. The GTV in the nasopharynx and positive lymph nodes in the neck received a prescription dose of 68-70 Gy and 60 Gy, respectively. All patients received full-course IMRT. Three patients who had positive lymph nodes were treated with five to six courses of chemotherapy (cisplatin + 5-fluorouracil) after IMRT. RESULTS: The treatment plans showed that the percentage of GTV receiving 95% of the prescribed dose (V(95-GTV)) was 98.5%, and the dose encompassing 95% of GTV (D(95-GTV)) was 68.1 Gy in the nasopharynx. The mean dose to the GTV was 71.4 Gy. The average doses of the surrounding critical structures were much lower than the tolerable thresholds. At a median follow-up of 9 months (range 3-13), the locoregional control rate was 100%. Three cases (6.1%) of locoregional residual disease were seen at the completion of IMRT, but had achieved a complete response at follow-up. Three patients developed metastases at a distant site: two in the bone and one in the liver and lung at 13 months follow-up. Acute toxicity (skin, mucosa, and xerostomia) was acceptable according to the Radiation Therapy Oncology Group criteria. Tumor necrosis was seen toward the end of IMRT in 14 patients (28.6%). CONCLUSION: The improvement in tumor target coverage and significant sparing of adjacent critical structures allow the feasibility of IMRT as a retreatment option for recurrent NPC after initial conventional RT. This is the first large series using IMRT to reirradiate local recurrent NPC after initial RT failed. The treatment-related toxicity profile was acceptable. The initial tumor response/local control was also very encouraging. In contrast to primary NPC, recurrent NPC reirradiated with high-dose IMRT led to the shedding of tumor necrotic tissue toward the end of RT. More patients and longer term follow-up are warranted to evaluate late toxicity and treatment outcome. SN - 0360-3016 UR - https://www.unboundmedicine.com/medline/citation/14967420/Initial_experience_using_intensity_modulated_radiotherapy_for_recurrent_nasopharyngeal_carcinoma_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0360301603015086 DB - PRIME DP - Unbound Medicine ER -